A Unique Approach To Homecare

Ontario Needs a Coordinated End-of-Life Care Policy

Posted by Jeff Durish

Thu, Jan 8, 2015

Health Quality Ontario recently published a
report that says Canada ranks 5th out of 40 countries on a quality-of-death index. That’s the good
news; the bad news is that the Canadian health care system lacks a national
strategy for end-of-life (EoL) care and depends on hospitals to provide
most of that care.

If you ask Canadians where and how they would prefer to die, most will
tell you they want to die at home surrounded by their loved ones, being
given care to make them comfortable, rather than trying to prolong life.
Yet almost 70% (almost 60% in Ontario) die in the hospital, more than
half of those in intensive care units, where the cost, both economic and
personal, is staggering.

Health care has reached the point where most Canadians die of advanced
chronic disease rather than acute illness. Only an estimated 30% of patientsCoordinated
End of Life Care have access to coordinated EoL care, and most of those
have cancer. As the population ages, the number who die each year will
increase 40% by 2026. This will put an enormous burden on an already overwhelmed
healthcare system if we don’t develop public policy to handle the
needs of those with advanced Alzheimer’s, heart disease, stroke,
COPD, and kidney disease, as well as those who are old and frail, but
do not have a defined disease that will cause death.

The factors that influence where and how people die include:

Lack of access to coordinated end-of-life care – Those who live in
rural areas and those with slow-progressing diseases such as kidney, pulmonary,
and heart disease may find it difficult to find EoL care except in a hospital.

Not completing an advance directive – Government regulations require
life-saving measures unless the patient has specifically stated that they
do not want them in certain circumstances. Many people don’t even
know what an advance directive is or how to complete one, and many confuse
“advance directive” with “power of attorney.” [See our
blog post on this subject.]

Not communicating their wishes to family members and doctors –Only
45% have spoken with their families about their wishes for EoL care; fewer
than 20% of patients have spoken with their doctors about it.

It’s a difficult subject, dying. It’s hard to sit down and
talk calmly and compassionately about a loved one’s death when it’s
not even on the horizon, and when it is imminent, it may be too late.
The cost of not doing so is immeasurably higher, both in terms of dollars
and more importantly, in terms of human emotion, when it’s delayed
too long. [See our series of posts (part 1,
part 2, and
part 3) for tips on how to handle the “the conversation.”]

A separate report by Health Quality Ontario listed a number of recommendations:

Every Ontarian should have access to specialized, team-based (coordinated),
end-of-life care

Doctors, patients and family caregivers should discuss advance care planning
early and as circumstances change

Home may not be the appropriate place of death. Patients, family caregivers
and health care providers should determine and discuss the best place
on an individual basis.

Patients and caregivers need to be better educated. Such subjects as symptom
management and coping strategies, as well as how to prepare documents
such as advance directives and powers of attorney, should be part of ongoing
education for patients and caregivers.

Health care providers should be educated specifically in end-of-life before
and after being licensed, including how to provide supportive care to
family caregivers.

Qualicare Toronto has always provided specialized palliative care with
a team-based approach. Our RN case managers and PSWs work as a team with
your palliative doctor to give patients and their families physical and
emotional support. Call us to discuss your options, at no cost and no
obligation.